January 11, 2010 - Heart disease and stroke is Switzerland’s number one cause of death and it is estimated that smoking increases the risk by 100 per cent, while the risk of death from undiagnosed coronary heart disease is increased by 300 per cent. Furthermore, there is overwhelming consensus among medical and scientific authorities that passive smoking is a major cause of disease in non-smokers, including coronary heart disease and cardiac death as well as lung cancer. (WORLD HEART FEDERATION URGES GENEVA TO VOTE FOR SMOKING BAN, 2/2/2008)
A ban on smoking in restaurants and bars in eastern Switzerland could have led to fewer heart attacks since its introduction, according to a recent medical study.
These first Swiss results come after similar findings in other countries, and constitute yet another indication that cigarettes play an important role in cardiac disease.
The smoking ban was introduced in canton Graubünden (Switzerland consists of 26 cantons - like counties) in March 2008. According to the study’s authors, although there is no clear correlation between the ban and cases of acute myocardial infarction [heart attacks], these fell 22 percent from March 2008 to February 2009 compared with 2006 and 2007.
In the two years before smoke-free legislation was introduced in Graubünden, 229 and 242 patients respectively from all over the canton were treated in Chur for acute myocardial infarction. After the ban, that number fell to 183 cases.
According to the lead author of the study, Piero Bonetti, the decrease is due mainly to fewer heart attacks among non-smokers. Passive smoking is believed to increase the risk of heart disease for this category by up to 30 per cent.
The other beneficiaries included people with a history of coronary disease and holidaymakers. Bonetti, a cardiologist in Chur, thinks this last category is influenced because people benefit quickly from being away from passive smoke.
But the study, which is published online by the Swiss Medical Weekly, does not establish direct causality between the smoking ban and heart disease. “Proving causality is impossible because there are only two ways of showing that,” admits Bonetti.
One solution would be to lift the smoking ban and see what happens. The other would be to study another population elsewhere with the same living conditions, but where no smoking ban has been implemented. “There have been no similar studies in Switzerland,” Bonetti told swissinfo.ch.
“The first study to show this was carried out in Helena, Montana where a smoking ban was lifted after six months. When it was first introduced, the incidence [of acute myocardial infarction] fell and when the ban was dropped, the number of cases rose again.” (Public smoking ban slashes heart attacks, by Shaoni Bhattacharya, NewScientist.com, 4/1/2003)
But Bonetti says that while causality cannot be proven, there is a strong case for a link between the ban and the number of heart attacks, especially given the lack of other obvious culprits.
“The strongest argument for causality is that more than ten studies worldwide have come up with similar results,” he said. “If you take all these studies together, you get an average decrease of 17 percent in the first year after a ban is implemented.” (Don't patronize places where people are smoking..)
The Institute of Medicine, one of the national academies in the United States, which carried out a so-called meta-analysis of these foreign studies, said this consistent data leads to the conclusion that smoking bans lead to fewer heart attacks. But it also pointed out that other factors associated with a ban such as education, information and outreach programmes can also have an impact. (U.S. IOM - like former Surgeon General Carmona stated there is no safe level of secondhand smoke..)
Some of those studies have also shown that the longer a ban has been in place, the higher the benefits.
Bonetti says the Graubünden study will continue, with data collection ongoing. Indications are that the first year results will be at least confirmed if not bettered. “It’s important to show this kind of results in a Swiss context even though similar studies have been done elsewhere,” he told swissinfo.ch. "You need local data to convince people that change is necessary.”
Around half of Swiss children regularly breathe air polluted by tobacco smoke, particularly at home, warns the International Union against Cancer (UICC). The UICC says 700 million children regularly breathe second-hand smoke. (Campaigners call for end to passive smoking)
Reference: Smoking ban linked to drop in heart attacks, Scott Capper, swissinfo.ch, 1/9/2010.
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